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International Journal of Existential Psychology & Psychotherapy Volume 3, Number 1 January, 2010
International Journal of Existential Psychology & Psychotherapy Volume 3, Number 1 January, 2010
International Journal of Existential Psychology & Psychotherapy Volume 3, Number 1 January, 2010
Exposition in existential
terms of a case of Negative
Schizophrenia approached
by means of Acceptance and
Commitment Therapy
Jos M. Garca-Montes*
Universidad de Almera
Marino Prez-lvarez
Universidad de Oviedo
*Corresponding author: Jos M. GarcaMontes. Universidad de Almera. Departamento de Personalidad, Evaluacin y
Tratamientos psicolgicos. La Caada de San
Urbano s/n. 04120-Almera. Spain.
Phone number: +34 950 01 50 92.
Fax: +34 950 01 54 71.
E-mail: jgmontes@ual.es
Abstract
The present work attempts to show,
through a case study, the possibilities of
Acceptance and Commitment Therapy
(ACT) applied from existential thought.
First of all we describe the symptoms referred to by a patient diagnosed as suffering from negative schizophrenia. These
symptoms are then analyzed in existential
terms, with special emphasis on the notion of personal identity. This is followed by a description of the intervention
carried out applying the techniques and
principles of ACT, and an account of the
patients evolution over two years. Finally,
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indeed, s/he who has chosen nothing is potentially everything, even though s/he may de
facto be nothing. The case of E. could be seen,
then, as an obstinate attempt at non-being;
that is, a way of trying to elude his necessary
freedom of action, and thus his construction
as a person. In this regard, it should be underlined that, as mentioned above, until the age
of 17 E. adjusted perfectly to the normative
models of his cultural context: good student,
sportsman, keen reader, etc. These types of
behaviour for which, we should remember, E.
did not feel ultimately responsible, may shape
what Laing (1960) has called a false self . As
Laing (1960) stresses, this bending oneself to
the norms or expectations of others is in part
a betrayal of ones possibilities, but it is also a
technique for concealing and preserving ones
true possibilities, that is, a way of playing at
not being that which one does.
Another form of trying to escape from the
condemnation to freedom could be seen
in the importance E. concedes to initiative. As we have seen, E. longs to have an
initiative so that he can act. This implies, in
fact, a mechanistic (almost mechanical) conception of his own activity. Its as though I
had a program, he remarked to us in one of
the sessions. E.s behaviour would thus be
a pure reflex determined by intentions, so
that his responsibility for his acts becomes
non-existent. Such behaviour was frequently
found in the sessions. Thus, for example, in
carrying out a written task we set for him
on the assessment of values (Hayes, Strosahl
& Wilson, 1999), he avoided practically all
responsibility with regard to the life-goals
considered. Instead of using verb forms such
as I want, I would like, I aim, etc., he
used expressions with I see or I see mywww.ExistentialPsychology.org
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and, in general, the importance of the construction of the identity in the development
and course of schizophrenia. This idea is far
from novel, having been mentioned by numerous authors (Chadwick, Birchwood, &
Trower, 1996; Harrop & Trower, 2001; Laing,
1960/1993; Niv, 1980; Sass, 1992). Here we
simply wish to add that, before anything else,
the construction of the identity is an existential question that, obviously, is not without
its difficulties in modern culture (Harrop &
Trower, 2001; Sass, 1992). Therefore, a comprehensive approach to schizophrenia cannot
ignore either the patients social context or
the vital problems s/he is facing at the time.
In the case of E. we saw the importance of,
for example, the concept of the condemnation to freedom and, in general, the work on
values aimed at enabling the client to develop
activities that progressively opened up new
roads for him.
A second consideration concerns the relevance that should be attributed to existential
questions in therapy supposedly based on acceptance. The founding authors of ACT have
studied the types of circumstances in which
acceptance would be a good intervention
strategy. Thus, for example, they cite those situations in which the very process of change is
in contradiction to the desired result (Hayes,
1994) or certain complex contingencies in
which a given achievement is necessarily accompanied by some losses (Dougher, 1994).
In our view, existential facts (the bodily nature of the human being, our condemnation
to freedom, the social nature of man, the
finite nature of life, etc.) constitute the area
in which acceptance becomes not just a good
therapeutic instrument, but the only techwww.ExistentialPsychology.org
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elective, thus giving rise to new combinations and, in turn, to improvements in health
(Prez, 2001).
REFERENCES
Bach, P. & Hayes, S. C. (2002). The use of
Acceptance and Commitment Therapy
to prevent the rehospitalization of
Psychotic Patients: a randomized controlled trial. Journal of Consulting and
Clinical Psychology. 70(5): 1129-1139
Chadwick, P., Birchwood, M., & Trower, P.
(1996). Cognitive Therapy for Illusions,
Voices and Paranoia. Chichester: Wiley.
Day, W. F. (1969). Radical behaviorism in
reconciliation with phenomenology.
Journal of the Experimental Analysis of
Behavior, 12, 2, 315-328.
Dougher, M. J. (1994). The act of acceptance.
In S. C. Hayes, N. S. Jacobson, V. M.
Follete & M. J. Dougher (Ed.). Acceptance and Change: content and context in
psychotherapy (pp. 37-45). Reno: Context Press.
Dougher, M. J. & Hayes, S. C. (1999). Clinical behavior analysis. In M. J. Dougher
(Ed.), Clinical Behavior Analysis. (pp.
11-25). Reno: Context Press.
Fallon, D. (1992). An existential look at B. F.
Skinner. American Psychologist, 47, 11,
1433-1440.
Garca, J. M. (2002). El papel de la supresin de
pensamientos auto-discrepantes sobre la
calidad perceptiva de las ilusiones auditivas. Oviedo: Publications service of the
University of Oviedo.
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